Accuracy of formulas used to predict post-transfusion packed cell volume rise in anemic dogs.

OBJECTIVE: To assess the accuracy of published formulas used to guide packed red blood cell (pRBC) transfusions in anemic dogs and to compare the predicted rise in packed cell volume (PCV) to the actual post-transfusion rise in PCV. DESIGN: Prospective observational study from April 2009 through July 2009. SETTING: A small animal emergency and specialty hospital. ANIMALS: Thirty-one anemic client-owned dogs that received pRBC transfusions for treatment of anemia. INTERVENTIONS: None MEASUREMENTS: Four formulas were evaluated to determine their predictive ability with respect to rise in PCV following transfusion with pRBC. Post-transfusion rise in PCV were compared to calculated rise in PCV using 4 different formulas. Bias and limits of agreement were investigated using Bland-Altman analyses. RESULTS: Accuracy of existing formulas to predict rise in PCV following transfusion varied significantly. Formula 1 (volume to be transfused [VT] [mL] = 1 mL × % PCV rise × kg body weight [BW]) overestimated the expected rise in PCV (mean difference, 6.30), while formula 2 (VT [mL] = 2 mL ×% PCV rise × kg BW) underestimated the rise in PCV (mean difference, -3.01). Formula 3 (VT [mL] = 90 mL × kg BW × [(desired PCV - Patient PCV)/PCV of donor blood]) and formula 4 (VT [mL] = 1.5 mL ×% PCV rise × kg BW) performed well (mean difference 0.23 and 0.09, respectively) in predicting rise in PCV following pRBC transfusion. CONCLUSIONS: Agreement between 2 formulas, "VT (mL) = kg BW × blood volume (90 mL) × [(desired PCV - recipient PCV)/Donor PCV]" and "VT (mL) = 1.5 ×desired rise in PCV × kg BW," was found when they were compared to the actual rise in PCV following pRBC transfusion in anemic dogs. Further research is warranted to determine whether these formulas perform similarly well for other species.

Magnetic resonance imaging susceptibility artifact due to pigmented intraorbital silicone prosthesis.

Magnetic resonance imaging (MRI) findings of two cases with intracranial disease and pigmented intraorbital prosthetics are presented. A brown prosthetic (Case 1) caused a significant magnetic susceptibility artifact, which necessitated removal to properly image the brain. The artifact observed on MRI images is likely due to ferromagnetic pigments used for coloring. A black prosthetic (Case 2) caused no imaging artifact. The carbon-based pigments used to color the black prosthetic implant do not appear to cause imaging artifact. The pigments currently used to color the brown pigmented orbital prostheses cause significant magnetic susceptibility artifact and may require removal to evaluate the brain and surrounding structures completely.

Surgical intervention in the management of severe acute pancreatitis in cats: 8 cases (2003-2007).

OBJECTIVE: To evaluate clinical characteristics and outcomes of cats undergoing surgical intervention in the course of treatment for severe acute pancreatitis. DESIGN: Retrospective observational study from 2003 to 2007 with a median follow-up period of 2.2 years (range 11 d-5.4 y) postoperatively. SETTING: Private referral veterinary center. ANIMALS: Eight cats. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Quantitative data included preoperative physical and clinicopathologic values. Qualitative parameters included preoperative ultrasonographic interpretation, perioperative and intraoperative feeding tube placement, presence of free abdominal fluid, intraoperative closed suction abdominal drain placement, postoperative complications, microbiological culture, and histopathology. Common presenting clinical signs included lethargy, anorexia, and vomiting. Leukocytosis and hyponatremia were present in 5 of 8 cats. Hypokalemia, increased total bilirubin, and hyperglycemia were present in 6 of 8 cats. Elevated alanine aminotransferase and aspartate transferase were present in all cats. Surgery for extrahepatic biliary obstruction was performed in 6 cats, pancreatic abscess in 3 cats, and pancreatic necrosis in 1 cat. Six of the 8 cats survived. Five of the 6 cats that underwent surgery for extrahepatic biliary obstruction and 1 cat that underwent pancreatic necrosectomy survived. All 5 of the cats with extrahepatic biliary obstruction secondary to pancreatitis survived. The 2 nonsurvivors included a cat with a pancreatic abscess and a cat with severe pancreatitis and extrahepatic biliary obstruction secondary to a mass at the gastroduodenal junction. Postoperative complications included progression of diabetes mellitus, septic peritonitis, local gastrostomy tube stoma inflammation, local gastrostomy tube stoma infection, and mild dermal suture reaction. CONCLUSION: Cats with severe acute pancreatitis and concomitant extrahepatic biliary obstruction, pancreatic necrosis, or pancreatic abscesses may benefit from surgical intervention. Cats with extrahepatic biliary obstruction secondary to severe acute pancreatitis may have a good prognosis.

Use of a nanocrystalline silver dressing and vacuum-assisted closure in a severely burned dog.

OBJECTIVE: To describe the first veterinary use of a nanocrystalline silver dressing (NSD) and use of vacuum-assisted closure (VAC) to treat a severely burned dog. CASE OR SERIES SUMMARY: A 1-year-old female intact American Staffordshire Terrier with 50% total body surface area burned was referred for definitive care approximately 18-24 hours post injury. The dog was treated with crystalloid fluids, hydroxyethyl starch, and antimicrobials based on culture and sensitivity results of wound cultures, fresh frozen plasma, human serum albumin, and packed red cells. Wound care initially consisted of daily debridement under anesthesia with silver sulfadiazine application and bandaging. Because of the extent and the location of the wounds and morbid state of the patient, early wound grafting was not an option. Because of its reported improvement in granulation tissue formation and decreased tissue edema, VAC was used once the majority of burned tissue was manually debrided. Because of the pain caused by VAC and traditional bandaging techniques with this extent of injury, an NSD was utilized. This strategy was chosen due to the antimicrobial properties of NSD and the reduced necessity for daily bandage changes, which was reduced to only every 3 days. This protocol reduced the need for daily sedation or anesthesia. NEW OR UNIQUE INFORMATION PROVIDED: VAC and NSD were used successfully for the treatment of a severe burn injury in a dog. The use of NSD decreased the cost of therapy by reducing the need for daily bandage changes, thereby reducing the anesthetic and analgesic costs and allowing the patient to be managed on an outpatient basis.

Characteristics and outcomes in surgical management of severe acute pancreatitis: 37 dogs (2001-2007).

OBJECTIVE: Describe clinical characteristics and outcomes associated with canine patients undergoing surgical intervention for treatment of acute pancreatitis. DESIGN: Retrospective outcome study from 2001 to 2007. ANIMALS: Thirty-seven dogs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The following data were collected for dogs who underwent surgical intervention in the course of treatment for severe acute pancreatitis: preoperative clinicopathologic and physical data, ultrasonographic findings, surgical procedure detail, histopathologic findings, and transfusion requirements. The survival rate was 80.8% in dogs with extrahepatic biliary obstruction, 64.3% in dogs undergoing necrosectomy, and 40.6% with pancreatic abscess. Overall survival was 63.6%. Surgical complications included intraoperative and postoperative hemorrhage in 12 dogs, postoperative development of diabetes mellitus in 3 dogs, exocrine pancreatic insufficiency in 1 dog, and bacterial peritonitis in 2 dogs. CONCLUSION: Surgical intervention and aggressive postoperative care may be pursued in select dogs with severe acute pancreatitis. In dogs with extrahepatic biliary obstruction secondary to acute pancreatitis, surgical intervention may be associated with a good prognosis whereas dogs with pancreatic abscess formation may have a more guarded prognosis.

Use of therapeutic plasmapheresis in a case of canine immune-mediated hemolytic anemia.

OBJECTIVE: To investigate the clinical application and potential utility of plasmapheresis in canine immune-mediated hemolytic anemia. CASE SUMMARY: A 7-year-old spayed female Maltese diagnosed with immune-mediated hemolytic anemia was initially treated with prednisone, cyclosporine, and received multiple transfusions of packed RBC. Because of the progression of clinical signs despite traditional medical therapy, plasmapheresis was initiated. Plasma immunoglobulin G and immunoglobulin M levels were measured before, during, and after treatment to help determine if there had been a significant decrease in immunoglobulin levels with plasmapheresis. Plasmapheresis was successfully performed over a 2.5-hour period in this dog with minimal complications. Hypocalcemia was identified as a known complication of circuit anticoagulation, and was corrected through calcium supplementation. Post-plasmapheresis there was a decrease in immunoglobulin G and immunoglobulin M levels, and the patient showed clinical improvement. Following discharge the dog had no known complications of therapy, and had complete resolution of the anemia. NEW OR UNIQUE INFORMATION PROVIDED: Plasmapheresis was performed successfully with minimal complications. Because transfusion requirements appeared to be reduced, and the procedure was well tolerated, there may be a place for this modality in severe cases to act as a bridge until medical therapy takes full effect. Because of the cost of performing this therapy, and the potential requirement for multiple treatments, it should be reserved for selected patients.

Rattlesnake envenomation.

Snake envenomation has been widely reported throughout the human and veterinary literature. The effects of venom include coagulation disorders, neurotoxicity, and tissue effects, such as local swelling and necrosis. Significant progress has been made in understanding the pathophysiology of envenomation, leading to changes in treatment protocols. Recent developments include the production of a new antivenin and a canine rattlesnake vaccine.

Two cases of planned relaparotomy for severe peritonitis secondary to gastrointestinal pathology.

Planned relaparotomy is a technique in which two or more surgeries are planned before or during the initial surgery. Two dogs underwent planned relaparotomy for severe peritonitis secondary to gastric ulceration and linear foreign body. Both dogs had good outcomes, and unnecessary procedures that would likely have led to increased morbidity were avoided. This technique may be useful in avoiding unnecessary procedures as well as providing for better stabilization of the animal.